Barw Barw Medical Journal 2960-1959 2025 09 28 Pregnancy and Challenging Transient Anti-GAD65 Positivity: A Case Report with Literature Review 77 81 10.58742/bmj.vi.207 eng Shaho F. Ahmed Endocrine Department, Shar Hospital, Malik Mahmud Ring Road, Sulaymaniyah, Iraq. shahomedi837@gmail.com Sharaza Q. Omer Laboratory Department, Shar Hospital, Malik Mahmood, Sulaymaniyah, Iraq. sharaza.omer12@gmail.com Rawezh Q. Salih Biology Department, College of Science, University of Sulaimani, Sulaymaniyah, Iraq. rawezh.salih@gmail.com Huda M. Muhammad College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. huda.muhammed@univsul.edu.iq Nahida H.A Ahmed Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. nahida.ahmed@gmail.com Jamal M. Salih College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. jamal.salih@gmail.com Aso N. Qadir Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. aso.qadir@gmail.com Karokh F. Hussein Gastroenterology Department, Gastroenterology and Hepatology Teaching Hospital, Zanko Street, Sulaymaniyah, Iraq. karokh.hussein@gmail.com Twana O. Saeed Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. twanaomar15@gmail.com 2025 07 28 Introduction During pregnancy, women may develop blood glucose abnormalities like gestational diabetes mellitus (GDM) or, rarely, type 1 diabetes (T1D), which can lead to complications. Anti-GAD65 is a key antibody used in diagnosing T1D. This study presents a rare case of T1D developing a week before birth, with transient anti-GAD65 positivity. Case presentation A 38-year-old patient who delivered a baby a week earlier and had high blood glucose was admitted to the hospital with shortness of breath, chest tightness, abdominal pain, generalized weakness, nausea, and repeated vomiting. She had elevated anti-GAD65 and was diagnosed with T1D and diabetic ketoacidosis. Insulin injection was prescribed, with lifestyle modifications, later oral hypoglycemic medications added. After a few months, both anti-IA2 and anti-GAD65 antibodies were negative. Literature review Seven cases of T1D during or after pregnancy were reviewed. Six reported BMI. The mean HbA1c was >7.63%. Mean anti-GAD65 was 190.74 U/mL, two were borderline and one negative. Six had previously diagnosed GDM. Treatments varied, including insulin and dietary management. All infants were safely delivered, one miscarried in a subsequent pregnancy. Insulin resistance increases during pregnancy due to hormonal changes, raising the risk of GDM, T1D, and type 2 diabetes. Emerging postpartum, often indicated by anti-GAD65 antibodies, though levels can fluctuate. Cases show complications like preeclampsia, DKA, and miscarriage. Early detection, strict glucose control, and monitoring antibody patterns are critical for managing risks and improving maternal and fetal outcomes. Conclusion Blood glucose should be monitored during pregnancy, and anti-GAD65 may signal T1D, requiring appropriate management.